SYMPTOMS OF NASAL DISEASE 19

reflex is an explosive one, and is accompanied by a twitching of the face and
eyes, and by an increased secretion of nasal mucus and tears, while there is a
transient engorgement of the nasal mucosa. Sneezing cannot be induced
voluntarily, but it is brought about by the inhalation of an irritant, such as
pepper, or an allergen in atopic individuals, or by looking at bright sunlight.

SNORING

Many individuals do not seek advice regarding snoring until pressed to do so
by their wife or husband, while parents may complain of snoring in their
children. The sound is made by vibrations of the soft palate while the patient
is asleep, often on his back, and during inspiration through the mouth. It has
been shown that a reservoir of air in the nasopharynx is essential for snoring,
and thus it is not found in complete nasal obstruction, e.g. a bilateral choanal
atresia. Snoring may occur in families, and this is usually due to a characteristic
configuration of the face and jaw, or in those with a short thick neck. One of
the facial characteristics is a receding chin, so that the tongue may slip
backwards. In children snoring may be due to hypertrophied adenoids with or
without hypertrophied tonsils, but it may also occur in the child with the high
arched palate and an underslung lower jaw which leaves a gap between the
upper and lower incisor teeth. Nasal allergic swelling of the mucous membrane
of the nose or a deflected nasal septum may result in snoring in children or
adults, while nasal polypi frequently cause it in adults. Collapse of one or both
alae nasi may give rise to snoring in adults (Fig. 15).

Fig. 15. Snoring due to collapsed ala nasi. (.Reproduced by permission of Mr Ian Robin and the
* Proceedings of the Royal Society of Medicine*.)

Treatment is that of the cause. In children removal of hypertrophied tonsils
and adenoids, or adenoids alone if the tonsils are of normal size, will usually
result in a cure. Removal of any intranasal cause, such as nasal polypi, or
correction of a deflected nasal septum, or treatment of nasal allergy should be
recommended. Collapse of the alae nasi should be treated by the insertion of
silver nasal dilators during the hours of sleep. Positive breathing exercises to
correct the weak dilator muscles should be advised. The open mouth may be
corrected by some form of chin strap, while correction of ill-fitting dentures
may prevent the tongue from slipping posteriorly. A cotton reel or other such
object fastened to the back of the pyjama jacket or nightdress will prevent the
snorer from sleeping on his back.

A cure is only obtained in some 50 per cent of cases.